Post on 31-Mar-2015
Exhibit ES-1. Summary Highlights: National and State-Level Estimates, Under-65 Population
People Percent of population
Millions 2012
National 2012
Lowest state
Highest state
Total: Insured but underinsured* or uninsured
79.0 29.5% 14% 38%
Insured but underinsured 31.7 11.8% 8% 17%
Uninsured 47.3 17.7% 4% 27%
Premiums exceed ACA thresholds** 29.2 10.9% 7% 14%
* Underinsured defined as insured in household that spent 10% or more of income on medical care (excluding premiums) or 5% or more if income under 200% poverty.** Affordable Care Act thresholds refers to the maximum premium contribution as a share of income in marketplaces or Medicaid.Data source: March 2012 and 2013 Current Population Surveys.
Exhibit 1. Uninsured or Underinsured: National Trends, Under-65 Population
2010millions
2011millions
2012millions
2012 percent of population
Uninsured 49.2 47.9 47.3 17.7%
Insured but underinsured* 29.9 30.6 31.7 11.8%
Total, uninsured or insured but underinsured
79.1 78.5 79.0 29.5%
* Underinsured defined as insured in household that spent 10% or more of income on medical care (excluding premiums) or 5% or more if income under 200% poverty. Data source: March 2011, 2012, and 2013 Current Population Surveys.
Exhibit 2. Distribution of Underinsured by Poverty, Under-65 Population, 2012
Less than 100% poverty100%–199% poverty200%–399% poverty400% poverty or more
Note: Sum of percentages or people may not equal total because of rounding.* Underinsured defined as insured in household that spent 10% or more of income on medical care (excluding premiums) or 5% or more if income under 200% poverty. Data source: March 2013 Current Population Survey.
Insured but underinsured:* 31.7 million people
16.0 million50%
9.7 million31%
4.2 million13%
1.7 million5%
Exhibit 3. Underinsured by State, 2011–2012Ranges from 8 percent to 17 percent of population
0
5
10
15
20
25
National average (2012): 12%
Percent of under-65 population
Note: Underinsured defined as insured in household that spent 10% or more of income on medical care (excluding premiums) or 5% or more if income under 200% poverty. Data source: March 2012–2013 Current Population Survey (states: two-year average).
Exhibit 4. Underinsured or Uninsured by State, 2011–2012Ranges from 14 percent to 38 percent of population
0
10
20
30
40
50 Uninsured Insured but underinsured*
National average (2012): 29%
* Underinsured defined as insured in household that spent 10% or more of income on medical care (excluding premiums) or 5% or more if income under 200% poverty. Data source: March 2012–2013 Current Population Survey (states: two-year average).
Percent of under-65 population
Exhibit 5. Distribution of Underinsured or Uninsured by Poverty, Under-65 Population, 2012
Less than 100% poverty100%–199% poverty200%–399% poverty400% poverty or more
* Underinsured defined as insured in household that spent 10% or more of income on medical care (excluding premiums) or 5% or more if income under 200% poverty. Data source: March 2013 Current Population Survey.
Insured but underinsured* or uninsured: 79 million people
33.3 million42%
23.2 million29%
15.6 million20%
6.8 million9%
Total Below 100%FPL
100%–199%FPL
200%–399%FPL
400% FPLor above
0
25
50
75
18
3327
156
12
30
20
6
2
Insured but underinsured* Uninsured
Notes: FPL = federal poverty level. Percentages may not sum to total because of rounding.* Underinsured defined as insured in household that spent 10% or more of income on medical care (excluding premiums) or 5% or more if income under 200% poverty. Data source: March 2013 Current Population Survey.
Exhibit 6. At Risk: 79 Million Uninsured or Underinsured, 2012
Percent of under-65 population
29
63
47
20
8
Exhibit 7. Middle-Income Uninsured or Underinsured by State, 2011–2012
Massach
usetts
Dist. o
f Columbia
Minnesota
Connecticu
t
Kentucky Iowa
Michigan
Indiana
Virginia
Ohio
Washington
Kansas
Mississ
ippi
South Dako
ta
GeorgiaIlli
nois
Louisia
na
West Virg
inia
Oklahoma
Arizona
California
North Carolin
aIdaho
Florid
aTexa
s
Wyoming
0
10
20
30
40
50 Uninsured Insured but underinsured*
National average (2012): 20%
Middle-income = 200%–399% of the federal poverty level. * Underinsured defined as insured in household that spent 10% or more of income on medical care (excluding premiums) or 5% or more if income under 200% poverty.Data source: March 2012–2013 Current Population Survey (states: two-year average).
Percent of middle-income population under age 65
Less than 17% 17%–19% 20%–22% 23%–28%
2003 2012
Exhibit 8. Total Premiums for Employer-Sponsored Insurance Rise Sharply as Share of Median Income for Under-65 Population, 2003 and 2012
Note: Premiums include employer and employee shares.Data sources: 2003, 2012 Medical Expenditure Panel Survey–Insurance Component; March 2004 and March 2013 Current Population Surveys for median income.
Four levels of cost-sharing: Bronze: actuarial value: 60% Silver: actuarial value: 70% Gold: actuarial value: 80% Platinum: actuarial value: 90%
Exhibit 9. Premium Tax Credits and Cost-Sharing Protections Under the Affordable Care Act
FPL Income Premium contribution as a share of income
Out-of-pocket limits
Actuarial value: if in Silver plan
<100% S: <$11,490F: <$23,550 0% (Medicaid) $0 (Medicaid) 100% (Medicaid)
100%–132% S: $11,490 – <$15,282F: $23,550 – <$31,322 2%, or 0% if Medicaid
S: $2,250F: $4,500
94%
133%–149% S: $15,282 – <$17,235F: $31,322 – <$35,325 3.0%–4.0% 94%
150%–199% S: $17,235 – <$22,980F: $35,325 – <$47,100 4.0%–6.3% 87%
200%–249% S: $22,980 – <$28,725F: $47,100 – <$58,875 6.3%–8.05% S: $5,200
F: $10,400 73%
250%–299% S: $28,725 – <$34,470F: $58,875 – <$70,650 8.05%–9.5%
S: $6,350F: $12,700
70%
300%–399% S: $34,470 – <$45,960F: $70,650 – <$94,200 9.5% 70%
400%+ S: $45,960+F: $94,200+ — —
Note: FPL refers to federal poverty level as of 2013. Actuarial values are the average percent of medical costs covered by a health plan. Premium and cost-sharing credits are for silver plan. Out-of-pocket limits for 2014.Source: Commonwealth Fund Health Reform Resource Center: What’s in the Affordable Care Act? (PL 111-148 and 111-152), http://www.commonwealthfund.org/Health-Reform/Health-Reform-Resource.aspx.
Note: Affordable Care Act thresholds refers to the maximum premium contribution as a share of income in marketplaces or Medicaid if eligible to participate. Data source: March 2012–2013 Current Population Survey (states: two-year average).
Percent of insured under age 65 who paid premiums that exceed ACA thresholds
Exhibit 10. Twenty-Nine Million Insured Paid Premiums in Excess of Affordable Care Act Thresholds, 2011–2012
15%–17% (15 states)12%–14% (27 states)
8%–11% (8 states + D.C.)
Exhibit 11. Distribution of Uninsured or Underinsured by Poverty, 2012
Less than 100% poverty 100%–137% poverty 138%–199% poverty200%–399% poverty 400% poverty or more
Notes: Percentages may not add to 100% because of rounding. Underinsured defined as insured in household that spent 10% or more of income on medical care (excluding premiums) or 5% or more if income under 200% poverty. Data source: March 2013 Current Population Survey.
37%17.4 million
24%11.3 million
13%4.2 million
50%16.0 million
13%6.2 million
13%4.1 million
15%7.3 million
18%5.7 million
11%5.1
million
5%1.7
mill-ion
47.3 million uninsured under age 65 in 2012
31.7 million underinsured under age 65 in 2012
Exhibit 12. Status of State Participation in Medicaid Expansion, as of March 2014
Note: The Centers for Medicare and Medicaid Services (CMS) has approved waivers for expansion with variation in Arkansas, Iowa, and Michigan. Pennsylvania’s waiver is currently under review by CMS.Source: Avalere State Reform Insights; Center of Budget and Policy Priorities; Politico.com; Commonwealth Fund analysis.
TX
FL
NMGA
AZ
CA
WY
NV
AK
OK
MS
LA
MT
TN
WA
ORID
UTCO
KS
NE
SD
ND
MN
WI
MO
IL INOH
KY
WV VA
NC
SC
AL
NY
ME
DCMD
DENJ CT
RIMA
NHVT
HI
Expanding (22 states + D.C.)
Not expanding (19 states)
Options under discussion (5 states)
Expanding with variation (4 states)
MI
IA
AR
PA